Thursday, February 23, 2017

Lessons from indigenous wisdom in the euthanasia debate.

How a person dies affects others, not just in the present but in the future.

Margaret Somerville

By Margaret Somerville

This Some time ago, I was a member of an ethics committee set up as part of the Nuclear Waste Management Organization established by the Canadian Government to advise it on how it should deal with the complex issue of the disposal of nuclear waste.

At the first meeting of the committee, the chairperson asked us each to introduce ourselves and to make some brief remarks relevant to the disposal issue.

George Erasmus, who was the national chief of the Assembly of First Nations from 1985 to 1991, was a committee member. When it came to his turn, after a long moment of silence, George said softly,

“Well if it had been up to us, we would never have been in this position, because we would never have allowed the technology that results in nuclear waste. We would have looked back seven generations for lessons from our ancestors and looked forward seven generations to its risks and harms to future generations and decided against its use.”

George’s words came to mind as wise advice for those of us engaging in the legalization of euthanasia debate currently raging in Australia. They struck me as especially apropos in light of the fact that Aboriginal and Torres Strait Island and First Nations communities in Australia and Canada, respectively, are, in my anecdotal experience, uniformly and adamantly opposed to euthanasia. What might these indigenous communities be perceiving that pro-euthanasia advocates are not?

Looking back: Hippocrates and ‘do not kill’

Looking back seven generations is to consult history or, as John Ralston Saul evocatively calls it, “human memory”.

Since the time of Hippocrates 2,400 years ago, medicine has a history of the absolute prohibition of physicians intentionally killing their patients. Why now do some people want to abandon this foundational value guiding the practice of medicine?

We have always been faced with death and suffering and have never seen euthanasia as ethically acceptable medical treatment or, indeed, as medical treatment. Why then, when there is so much more we can do to relieve suffering, might our society suddenly think it is a good idea to allow doctors to inflict death? The contributing factors are multiple and complex, but at base the cause is a sole focus on upholding the individual’s absolute right to autonomy and “choice”, to the exclusion of other balancing considerations that should be taken into account.

These other considerations include what approach is needed to protect the common good, that is the wellbeing of the community as a whole, not just the wishes and claims of an individual person, important as these are. The cultures of indigenous peoples are more cognisant of this need to protect the community and attuned to it, which could be one reason they reject euthanasia.

Pro-euthanasia advocates adamantly reject that the history of the Nazi horrors has anything to teach us and scorn anyone who dares to suggest that, when judiciously examined, it might provide insights and warnings. It’s true that we will not see a Holocaust resulting from the legalization of euthanasia, but the origins of the Holocaust in German doctors’ involvement in small, allegedly well-motivated and compassionate medical acts and the justifications used to validate these acts carry serious warnings that deserve attention in the current debate.

Looking forward: what we do now affects our great-grandchildren

In using their imaginations to look forward seven generations in order to be warned of future harms and risks to their descendants, indigenous communities are again seeking to protect not only individuals, but also the community. How a person dies, when death is caused by euthanasia, affects not only that person, but also unavoidably affects others and the community, and not just in the present but also in the future.

To summarize: the strongest case for legalizing euthanasia is based in radical individualism and “presentism”. It focuses on a suffering, competent adult individual who asks for and gives informed consent to euthanasia to the exclusion of the impact on the community of allowing euthanasia, and ignores what we could learn from considering it in the context of both the past and the future.

So in deciding about legalizing euthanasia we should learn an important lesson from indigenous wisdom and ask ourselves questions which include: How do we not want our great-great-grandchildren to die? What must we not do now if we are to leave to future generations a society in which reasonable people would want to live? Would an Australian society in which euthanasia had become a norm be such a society?

In thinking about that last question, further realities can be brought to light. If, as Andrew Denton claims, Australia will have the same rate of deaths by euthanasia as the Netherlands and Belgium, around 4 percent of all deaths, that will result in around 6000 euthanasia deaths annually, which would make euthanasia the sixth leading cause of death in Australia. It would fall between respiratory diseases and diabetes on the Australian Bureau of Statistics “Causes of Death 2015” list, and there would be 25 percent more deaths by euthanasia than from diabetes, five times the number of deaths from road accidents (1200 per annum) and twice the number of deaths from suicide (3000 per annum). Could we accept that?

The population of the Victorian town of Lakes Entrance is just under 6000. Would we be comfortable with wiping out with euthanasia each year the same number of people who presently live in that town?

Margaret Somerville was Samuel Gale Professor of Law, Professor in the Faculty of Medicine, and Founding Director of the Centre for Medicine, Ethics and Law at McGill University, Montreal. Margaret Somerville is now a Professor of Bioethics in the School of Medicine at the University of Notre Dame Australia. Her most recent book is Bird on an Ethics Wire: Battles about Values in the Culture Wars.